Long-term Trends Analysis Of Upper Gastrointestinal Cancers And Evaluation Of The Early Detection And Treatment Program In Yangzhong City

BackgroundMalignant cancer is a leading cause of death that seriously affects human health.According to the report(GLOBOCAN 2012)by WHO International Agency for Research on Cancer(IARC),there were 3.07 million new incident cancer cases and 2.21 million cancer death in China in 2012,including 405000 incident gastric cancer cases and 325000 gastric cancer-related death and 223000 incident esophageal cancer cases and 197000 esophageal cancer related-death.The gastric cancer and esophageal cancer have been ranked as the third and fourth cause of cancer death,respectively.Yangzhong county is one of the high risk areas of upper gastrointestinal cancers in China.The high incidence and mortality rates of gastric and esophageal cancer have put a heavy burden on local health care system and economic development.ObjectiveThis study described the long-term trends of incidence and mortality of upper gastrointestinal cancers during 1991 to 2013 in Yangzhong,and further to make a comprehensive evaluation on an early detection and treatment projects of gastric and esophageal cancer using the endoscopic screening method since 2006 in Yangzhong.MethodsThis paper consisted of two parts.Firstly,based on the cancer registration data during 1991-2013 in Yangzhong County,we calculated the crude rates,age-standardized rates and age-specific rates of incidence and mortality for gastric and esophageal cancer.The Joinpoint Regression Program was used to estimate the annual percentage of change(APC)and 95%confidence interval(CI).The Graphpad Prism was used to draw the trend plot and survival curve.In the second part,we collected data of local residents aged 40-69 years who participated a free endoscopic screening program since 2006 through 2012.We described their demographic characteristics and clinical features.Patients detected with gastric and esophageal cancer were followed up until December 31,2013.We further compared the survival rate of patients diagnosed through the endoscopic screening program and those diagnosed through usual hospital visits because of illness by frequency matching with age.The observed survival rates were calculated by the Kaplan-Meier method,and the log-rank test was used to compare the survival time between groups.Results1.From 1991 to 2013,8537 patients were diagnosed with gastric cancer,of which 5459(63.9%)were male and 3078(36.1%)were female.The crude incidence rate of gastric cancer declined throughout the study period,and the age-standardized incidence rate declined significantly from 165.11/105(male:225.39/105;female:113.34/105)in 1991 to 53.46/105(male:76.51/105;female:32.43/105)in 2013.The APC was-3.6%(95%CI:-4.5,-2.7)for males(P<0.01)and-4.8%(95%CI:-5.7,-3.9)for females(P<0.01),according to the age-standardized incidence rate.The age-specific rates were relatively low in populations younger than 45 years old and then increased significantly with age,reaching its peak at 70-74 years old.The age-standardized mortality rate for gastric cancer fluctuated during 1992(81.59/105)and 2001(71.85/105),and then decreased significantly from 2002(66.43/105)to 2011(17.37/105),with an APC of-13.5%(95%CI:-16.9,-10.0;P<0.01).2.From 1991 to 2013,6493 esophageal cancer cases were identified in Yangzhong County.Among them,3446(53.1%)were male and 3047(46.9%)were female.The crude incidence rate of esophageal cancer was relatively stable during the study period,but the age-standardized incidence significantly decreased from 107.06/105(male:118.05/105;female:97.42/105)in 1991 to 37.04/105(male:46.43/105;female:27.26/105)in2013,with an APC of-2.5%(95%CI:-3.4,-1.5)for males(P<0.01)and-4.9%(95%CI:-5.8,-3.9)for females(P<0.01).The age-specific rates were relatively low in populations younger than 40 years old and increased with age,reaching its peak at 75~79 years of age.The age-specific rate was higher in males than in females for each age group.The age-standardized mortality rate for esophageal cancer increased from 1991(25.15/105)to 1993(62.94/105),remained stable from 1994(56.38/105)to 2003(50.78/105)and then decreased from 2004(45.32/105)to 2011(13.98/105),with a significant APC of-17.7%(95%CI:-26.2,-8.3;P<0.01).3.From 2006 to 2012,12,453 people were screened,including 5334(42.8%)men and 7119(57.2%)women.166 upper digestive tract cancers were detected,including 106 in esophagus(detection rate:0.85%)and 60 in stomach(detection rate:0.48%).Among them,98.11%patients with esophageal cancer and 100%patients with gastric cancer were detected at the early stage.The overall survival rates for 1 year,3 years and 5 years were 98.0%,90.0%and 89.0%,respectively.Compared with those diagnosed through usual hospital visits because of symptoms and signs,a significantly positive effect was observed on the long-term survival for patients being detected through the massive endoscopic screening(Log-rank test X2=333.2,P<0.001).ConclusionsThe incidence and mortality rate of gastric and esophageal cancer in Yangzhong County were higher than the national average rate.The age-standardized incidence rates of both esophageal and gastric cancer continuously decreased from 1991 to 2013.The survival of patients detected in the endoscopic screening program was significantly better than that of age-matched controls diagnosed through regular hospital visits because of symptoms and signs.But the cost-effectiveness and acceptability of endoscopic screening need to be further evaluated.